An Open Letter to Baroness Warnock on Assisted Suicide

When she said people with Alzheimer's should be able to appoint someone to request euthanasia for them, Britain's leading medical ethicist, Baroness Mary Warnock, caused a firestorm of controversy. A similar, but little known, proposal was made by those in the forefront of Oregon's assisted-suicide law and the current Washington State initiative to legalize assisted suicide.

The following open letter to Baroness Warnock explains how she will be far more likely to move toward her goal if she follows the Oregon model.

Dear Baroness,

Your recent interview on a duty to die certainly caused a stir when you said you hope people will soon be licensed to "put down" those who are unable to look after themselves. To hear the fuss from commentators around the world, one would think you'd never expressed that idea before. But I imagine few people read about a lecture you gave at Giggleswick School in 1990 where you said virtually the same thing. Truth be told, when I first read the account of that lecture in the Craven Herald and Pioneer, I thought it was a very bad joke. Maybe that was due, in part, to the name of the school. Not being a Brit, I didn't realize what a prestigious institution it is. Still, I thought it was a bit radical to suggest that some people were "quite unambiguously entitled to end the life of those whose life chances are seen as very poor."

I can see now that you really meant it then and that you haven't budged in your stance. However, in your latest call for designated death deciders you really went over the top when you pointed out that it would save money for the National Health Service. And you hurt your own cause.

Quite frankly, Baroness, it's time to face the fact that it has been eighteen years since you first voiced your proposal in an open forum and you're no closer now than you were then to achieving your goal. If you want to succeed, you really must change your approach.

You may want to consider following a model that seems to be working here "across the pond."

That model is from Oregon. It started with a proposal much like yours. In 1991, Senator Frank Roberts sponsored a measure (SB 1191) to permit "aid-in-dying," defined as "a medical procedure" performed by a physician "to end the life of a patient in a dignified, painless and humane manner." Of course, it meant killing the patient with a lethal injection but, you'll note, that the soft phrase, "aid-in-dying," was used. That's an important point since words like "euthanasia," "assisted suicide" or, as you say, "put others down" really turn people off.

Senator Roberts' legislative aide was Barbara Coombs Lee. (Keep that name in mind, Baroness. You really do want to emulate what she has done over the years.) Lee worked to gain approval for the proposal. But, despite the euphemistic phrases and Lee's hard work, the measure failed. It had several fatal flaws that made it unpalatable.

First, the printed version of the bill noted that it was sponsored "at the request of the Hemlock Society," making it far too clear that a special interest euthanasia advocacy group was behind it. Second, it went too far, too fast. It provided that an individual could give another person the right to "instruct my physician to provide assistance in ending my life in a painless, dignified and humane manner if I have a fatal disease such as advanced Alzheimer's disease that makes me unable to speak intelligibly...."

Sound familiar to you? It should, since it's exactly what you're calling for.

But, at the time, it was just too much for people in Oregon to swallow.

The backers of the measure could have just kept proposing the same bill over and over, but they didn't. Unlike your, dare I say, stubborn insistence on pushing for everything at once, assisted-suicide and euthanasia activists here learned from their failure. They realized they had to change their image from that of Hemlockian activism to one of compassionate concern.

The players didn't change, but the script did. Three years after Roberts' euthanasia-for-Alzheimer's-patients bill failed, Barbara Coombs Lee became the chief petitioner for Measure 16, Oregon's "Death with Dignity Act." By then she was vice president of a fast-growing managed care company and was working with Compassion in Dying (a spin-off of the Hemlock Society.) Unlike the earlier legislative measure, this one went directly to the voters. It was a scaled back proposal, permitting assisted suicide only (not euthanasia by lethal injection). And it didn't make any provisions for a third party to request an incompetent patient's death. Additionally, politically savvy campaigners made sure that the chilling name, "Hemlock," was no longer attached to the push to legalize assisted suicide.

Another twist was added as well. During the campaign prior to the vote, proponents of the assisted-suicide bill played on Oregon's anti-Catholic biases. They deluged the airwaves, telling voters that the Catholic Church was behind all opposition to the bill and that one religion was trying to deny dying patients the right to choose death with dignity.

The strategy worked. Oregon's "Death with Dignity Act" passed by a vote of 51 - 49% in November 1994 and went into effect three years later.

Baroness, can you see how this process works?

It's really quite simple.

Remember, you need to take things step-by-step; use carefully-chosen, comforting words to describe what you are proposing and find a bête noire (such as the Catholic Church or evangelical Christians). Above all, you must be ready to make changes if something isn't working.

When Oregon's assisted-suicide law passed, those who share your views thought they would rapidly achieve similar victories, but that didn't happen. In fact, in the ensuing years, Oregon-style laws were proposed in twenty-three states (multiple times in some of those states). Yet, each and every one of them failed.

That didn't stop your U.S. counterparts. They forged ahead. They solidified their organizational structure, changing their name to Compassion & Choices (by merging the Hemlock Society and Compassion in Dying). And, most important, they collected "proof" that Oregon's law is working well.

Under Oregon's law, doctors who prescribe lethal drugs for patients must file reports with the state and, then, that information is used to formulate official annual reports. And, since Compassion & Choices has arranged and participated in 75% of the state's assisted-suicide deaths, it has maintained control of most information contained in annual reports. (Oregon officials acknowledge that there is no way to verify whether the self-reporting by assisted-suicide-prescribing doctors is accurate or complete.) All that can be claimed with certainty, is that, after ten years of assisted suicide in Oregon, there have now been ten annual official reports which are, at best, questionable. Nonetheless, this "proof" has become the most powerful tool for those who share your views. They've been able to claim that there have been absolutely no problems or abuses.

Baroness, you might think the Oregon statistics are not relevant to your efforts in Britain but, I assure you, those figures have and will continue to be an important part of the arsenal of anyone, anywhere, who is promoting assisted suicide and euthanasia.

If you are wondering whether your statements - which have, until now, been counterproductive - have somehow disqualified you from being effective in the future, I want to reassure you.

The same people who have previously failed can be very effective as long as they change their words and strategy. Their experience with the 1991 euthanasia-for-Alzheimers'-patients proposal in Oregon did not require its early supporters to bow out of the action.

For example, a few weeks ago, just as you were making your counterproductive "putting people down" statement, your far more savvy American counterparts - who are currently engaged in an assisted-suicide initiative campaign in Washington State (I-1000) - were pointing at Oregon as a model of compassion and choice. In a letter to the editor of the Seattle Post-Intelligencer, former Oregon governor Barbara Roberts assured Washingtonians that "I-1000 is not a slippery slope." Roberts is the widow of Senator Frank Roberts who, you recall, introduced the failed euthanasia-for-Alzheimers-patients measure.

Omitted from her letter was any mention of the fact that, in Oregon, some patients are now being told that their health care plan will pay for assisted suicide, but not for life-saving treatment that their doctors prescribe.

You see, Baroness, once an assisted-suicide law is passed, it can be used to save money. But Roberts is smart enough to know that mentioning the cost containment aspect would cause Washington voters recoil from an Oregon-style assisted suicide law. Instead, she painted the Oregon experience with rosy hues, describing "beautiful accounts of compassion, sharing, dignity and gentle exits."

It should come as no surprise that she also failed to mention Barbara Coombs Lee's leadership in the Washington effort, even though Lee is the current president of Compassion & Choices, which has poured hundreds of thousands of dollars into the Washington State effort. In a recent letter to supporters, Lee wrote, "Very soon - with your help, Washington State could be the next to pass an Oregon-style aid-in-dying law."

By now you should realize that Lee has been very effective in the years since she first worked on a proposal that mirrored yours. And, Baroness, you can also be effective. All you need to do is remember a few crucial points:

Be very careful with language. Use soothing phrases.

Don't try to achieve your entire goal at one time. Use a step-by-step approach.

Manufacture statistics. Use them to bolster your claims, whatever they are.

Portray any opposition as "anti-choice religious zealots."

Keep all focus on the current proposal. Never discuss your plans for expansion.

Always portray your motivation as caring and compassionate. Never, ever, let anyone know that you see legalized assisted suicide and euthanasia as a means of cost containment.

If you follow these few simple steps, you could be well on your way to achieving your end goal. You might want to reflect on the sentiments expressed by Booth Gardner, the former governor of Washington State and the principle spokesperson for the current Washington campaign. In December 2007, Gardner was interviewed by The New York Times Magazine. According to that article:

Gardner's campaign is a compromise; he sees it as a first step. If he can sway Washington to embrace a restrictive law, then other states will follow. And gradually, he says, the nation's resistance will subside, the culture will shift and laws with more latitude will be passed...."

In closing, Baroness, I hope this advice has given you some guidance in how you can be more effective.

However, more than that, I hope those who read this advice will see you as an ethics guru, grown arrogant by too much deference, whose agenda is a cold, cruel dismissal of the lives of those who are most vulnerable. Furthermore, I hope they will recognize that Washington's assisted-suicide proposal and Oregon's law are rooted in the same mentality.

When she said people with Alzheimer's should be able to appoint someone to request euthanasia for them, Britain's leading medical ethicist, Baroness Mary Warnock, caused a firestorm of controversy. A similar, but little known, proposal was made by those in the forefront of Oregon's assisted-suicide law and the current Washington State initiative to legalize assisted suicide.

The following open letter to Baroness Warnock explains how she will be far more likely to move toward her goal if she follows the Oregon model.

Dear Baroness,

Your recent interview on a duty to die certainly caused a stir when you said you hope people will soon be licensed to "put down" those who are unable to look after themselves. To hear the fuss from commentators around the world, one would think you'd never expressed that idea before. But I imagine few people read about a lecture you gave at Giggleswick School in 1990 where you said virtually the same thing. Truth be told, when I first read the account of that lecture in the Craven Herald and Pioneer, I thought it was a very bad joke. Maybe that was due, in part, to the name of the school. Not being a Brit, I didn't realize what a prestigious institution it is. Still, I thought it was a bit radical to suggest that some people were "quite unambiguously entitled to end the life of those whose life chances are seen as very poor."

I can see now that you really meant it then and that you haven't budged in your stance. However, in your latest call for designated death deciders you really went over the top when you pointed out that it would save money for the National Health Service. And you hurt your own cause.

Quite frankly, Baroness, it's time to face the fact that it has been eighteen years since you first voiced your proposal in an open forum and you're no closer now than you were then to achieving your goal. If you want to succeed, you really must change your approach.

You may want to consider following a model that seems to be working here "across the pond."

That model is from Oregon. It started with a proposal much like yours. In 1991, Senator Frank Roberts sponsored a measure (SB 1191) to permit "aid-in-dying," defined as "a medical procedure" performed by a physician "to end the life of a patient in a dignified, painless and humane manner." Of course, it meant killing the patient with a lethal injection but, you'll note, that the soft phrase, "aid-in-dying," was used. That's an important point since words like "euthanasia," "assisted suicide" or, as you say, "put others down" really turn people off.

Senator Roberts' legislative aide was Barbara Coombs Lee. (Keep that name in mind, Baroness. You really do want to emulate what she has done over the years.) Lee worked to gain approval for the proposal. But, despite the euphemistic phrases and Lee's hard work, the measure failed. It had several fatal flaws that made it unpalatable.

First, the printed version of the bill noted that it was sponsored "at the request of the Hemlock Society," making it far too clear that a special interest euthanasia advocacy group was behind it. Second, it went too far, too fast. It provided that an individual could give another person the right to "instruct my physician to provide assistance in ending my life in a painless, dignified and humane manner if I have a fatal disease such as advanced Alzheimer's disease that makes me unable to speak intelligibly...."

Sound familiar to you? It should, since it's exactly what you're calling for.

But, at the time, it was just too much for people in Oregon to swallow.

The backers of the measure could have just kept proposing the same bill over and over, but they didn't. Unlike your, dare I say, stubborn insistence on pushing for everything at once, assisted-suicide and euthanasia activists here learned from their failure. They realized they had to change their image from that of Hemlockian activism to one of compassionate concern.

The players didn't change, but the script did. Three years after Roberts' euthanasia-for-Alzheimer's-patients bill failed, Barbara Coombs Lee became the chief petitioner for Measure 16, Oregon's "Death with Dignity Act." By then she was vice president of a fast-growing managed care company and was working with Compassion in Dying (a spin-off of the Hemlock Society.) Unlike the earlier legislative measure, this one went directly to the voters. It was a scaled back proposal, permitting assisted suicide only (not euthanasia by lethal injection). And it didn't make any provisions for a third party to request an incompetent patient's death. Additionally, politically savvy campaigners made sure that the chilling name, "Hemlock," was no longer attached to the push to legalize assisted suicide.

Another twist was added as well. During the campaign prior to the vote, proponents of the assisted-suicide bill played on Oregon's anti-Catholic biases. They deluged the airwaves, telling voters that the Catholic Church was behind all opposition to the bill and that one religion was trying to deny dying patients the right to choose death with dignity.

The strategy worked. Oregon's "Death with Dignity Act" passed by a vote of 51 - 49% in November 1994 and went into effect three years later.

Baroness, can you see how this process works?

It's really quite simple.

Remember, you need to take things step-by-step; use carefully-chosen, comforting words to describe what you are proposing and find a bête noire (such as the Catholic Church or evangelical Christians). Above all, you must be ready to make changes if something isn't working.

When Oregon's assisted-suicide law passed, those who share your views thought they would rapidly achieve similar victories, but that didn't happen. In fact, in the ensuing years, Oregon-style laws were proposed in twenty-three states (multiple times in some of those states). Yet, each and every one of them failed.

That didn't stop your U.S. counterparts. They forged ahead. They solidified their organizational structure, changing their name to Compassion & Choices (by merging the Hemlock Society and Compassion in Dying). And, most important, they collected "proof" that Oregon's law is working well.

Under Oregon's law, doctors who prescribe lethal drugs for patients must file reports with the state and, then, that information is used to formulate official annual reports. And, since Compassion & Choices has arranged and participated in 75% of the state's assisted-suicide deaths, it has maintained control of most information contained in annual reports. (Oregon officials acknowledge that there is no way to verify whether the self-reporting by assisted-suicide-prescribing doctors is accurate or complete.) All that can be claimed with certainty, is that, after ten years of assisted suicide in Oregon, there have now been ten annual official reports which are, at best, questionable. Nonetheless, this "proof" has become the most powerful tool for those who share your views. They've been able to claim that there have been absolutely no problems or abuses.

Baroness, you might think the Oregon statistics are not relevant to your efforts in Britain but, I assure you, those figures have and will continue to be an important part of the arsenal of anyone, anywhere, who is promoting assisted suicide and euthanasia.

If you are wondering whether your statements - which have, until now, been counterproductive - have somehow disqualified you from being effective in the future, I want to reassure you.

The same people who have previously failed can be very effective as long as they change their words and strategy. Their experience with the 1991 euthanasia-for-Alzheimers'-patients proposal in Oregon did not require its early supporters to bow out of the action.

For example, a few weeks ago, just as you were making your counterproductive "putting people down" statement, your far more savvy American counterparts - who are currently engaged in an assisted-suicide initiative campaign in Washington State (I-1000) - were pointing at Oregon as a model of compassion and choice. In a letter to the editor of the Seattle Post-Intelligencer, former Oregon governor Barbara Roberts assured Washingtonians that "I-1000 is not a slippery slope." Roberts is the widow of Senator Frank Roberts who, you recall, introduced the failed euthanasia-for-Alzheimers-patients measure.

Omitted from her letter was any mention of the fact that, in Oregon, some patients are now being told that their health care plan will pay for assisted suicide, but not for life-saving treatment that their doctors prescribe.

You see, Baroness, once an assisted-suicide law is passed, it can be used to save money. But Roberts is smart enough to know that mentioning the cost containment aspect would cause Washington voters recoil from an Oregon-style assisted suicide law. Instead, she painted the Oregon experience with rosy hues, describing "beautiful accounts of compassion, sharing, dignity and gentle exits."

It should come as no surprise that she also failed to mention Barbara Coombs Lee's leadership in the Washington effort, even though Lee is the current president of Compassion & Choices, which has poured hundreds of thousands of dollars into the Washington State effort. In a recent letter to supporters, Lee wrote, "Very soon - with your help, Washington State could be the next to pass an Oregon-style aid-in-dying law."

By now you should realize that Lee has been very effective in the years since she first worked on a proposal that mirrored yours. And, Baroness, you can also be effective. All you need to do is remember a few crucial points:

Be very careful with language. Use soothing phrases.

Don't try to achieve your entire goal at one time. Use a step-by-step approach.

Manufacture statistics. Use them to bolster your claims, whatever they are.

Portray any opposition as "anti-choice religious zealots."

Keep all focus on the current proposal. Never discuss your plans for expansion.

Always portray your motivation as caring and compassionate. Never, ever, let anyone know that you see legalized assisted suicide and euthanasia as a means of cost containment.

If you follow these few simple steps, you could be well on your way to achieving your end goal. You might want to reflect on the sentiments expressed by Booth Gardner, the former governor of Washington State and the principle spokesperson for the current Washington campaign. In December 2007, Gardner was interviewed by The New York Times Magazine. According to that article:

Gardner's campaign is a compromise; he sees it as a first step. If he can sway Washington to embrace a restrictive law, then other states will follow. And gradually, he says, the nation's resistance will subside, the culture will shift and laws with more latitude will be passed...."

In closing, Baroness, I hope this advice has given you some guidance in how you can be more effective.

However, more than that, I hope those who read this advice will see you as an ethics guru, grown arrogant by too much deference, whose agenda is a cold, cruel dismissal of the lives of those who are most vulnerable. Furthermore, I hope they will recognize that Washington's assisted-suicide proposal and Oregon's law are rooted in the same mentality.